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By Megan Hoert Hughes, STEM Diversity Program Manager and Environmental Health Educator, UNC Institute for the Environment and Center for Environmental Health and Susceptibility

North Carolina Healthy Homes Forum participants represented 13 counties. The black line indicates Interstate-95 which is typically considered the region of the state with the oldest housing. (click to enlarge)

The Community Engagement Core (CEC) in the UNC Center for Environmental Health and Susceptibility (CEHS), uses peer reviewed research to enhance environmental health literacy among public health professionals and vulnerable populations susceptible to childhood lead poisoning, asthma exacerbations, and other health conditions related to substandard housing. On September 19, 2019, the Community Engagement Core (CEC) brought together 13 Healthy Homes programs from across North Carolina for a daylong forum designed to respond to the needs expressed by public health and housing professionals, as well as community partners, in a recent needs assessment survey.

Asthma is a chronic lung disease that affects about 1 in 10 North Carolina residents (8 percent of adults and 10 percent of children). Survey data from the North Carolina State Center for Health Statistics Child Assessment and Monitoring Program (CHAMP) indicate that about 25% of North Carolina children with asthma miss one or more weeks of daycare or school each year due to asthma related illness. Nearly 1/3 of these children visit the emergency department or urgent care clinic at least annually because of asthma. Another urgent health issue in North Carolina is lead poisoning.  In 2017, over 1,500 children age 1-2 years tested in North Carolina had a blood lead level that required intervention by a health care professional. Notably, 40% of homes in the state were built before 1978, making them likely to have lead-based paint.

Healthy Homes Forum participants, along with Environmental Health Outreach Manager, Neasha Graves, draw a diagram of their current program (black) and then indicate new ideas for evaluation (orange), patient recruitment (blue), and partnerships (purple).

Asthma home assessment programs have been shown to improve health outcomes associated with asthma if they address multiple triggers (such as tobacco smoke, pests, mold, and/or products like cleaners and air fresheners) in the home at the same time (Krieger et al., 2017). These programs, known as “Healthy Homes” programs are designed by the Centers for Disease Control and the Environmental Protection Agency to help families identify environmental asthma triggers and take action to eliminate them. In the most common model, asthma patients are visited in their home by a professional who makes recommendations about how to reduce asthma triggers related to mold and moisture, pests and pesticides, and indoor air quality. Professionals also look for lead and safety hazards.

The forum was supported by the National Institute of Environmental Health Sciences (NIEHS) (grant #P30ES010126), providing an opportunity for local home visiting programs to engage with and learn from each other and experts in implementing home visiting initiatives. Guest presenters included Ryan Allenbrand, the Healthy Homes Program Manager with Children’s Mercy in Kansas City and Sharon Beard, MS, an Industrial Hygienist with the NIEHS Worker Training Program. Presentations, a panel discussion and interactive program planning sessions helped participants gain insight on evaluating a home visitor program, identifying and recruiting partner agencies, and recruiting and retaining clients and patients into home visiting programs. Presentations and resources from the forum are available at the UNC-CEHS website.

Source: Krieger, J., et al (2017). The Seattle–King County Healthy Homes Project: Implementation of a Comprehensive Approach to Improving Indoor Environmental Quality for Low-Income Children with Asthma (chapter 3), Community Research in Environmental Health: Studies in Science, Advocacy and Ethics, London, England.

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